Pediatric Erythema Leprosum Necroticans Presenting as Emergency

Lepromatous leprosy is considered rare in children owing to the immature immune system. Lepra reaction, although not uncommon, type-2 lepra reaction in childhood is scarcely reported. We report five such cases, all presented in our institutes' emergency department with severe type-2 lepra reaction as the presenting entity. They had multiple classical features of leprosy, like ulcero-necrotic lesions, deformity, neuritis, and high slit smear bacillary index, which are otherwise usual in adult leprosy and not seen in childhood leprosy. Childhood leprosy being an indicator of active transmission in the community, these cases are crucial from the rarity viewpoint but also a pointer of recrudescence in the post-elimination era, highlighting the need for more aggressive case detection and better active surveillance.